It used to be so easy—Part 1

Cystic fibrosis (CF) used to be so simple. The lower airway is sterile (the Professors said so, so it had to be true) and CF bronchial infections were related to three main bugs (Staph, Haemophilus, Pseudomonas aeruginosa) and the occasional odd gram negative funny if you were unlucky. Now, proving yet again that the more senior and dogmatic the Professor, the more likely they are wrong, we know from molecular techniques that the airway is teaming with bacteria (PLoS One 2010;5:e8578) and similar techniques have also taught us that the CF lower airway is a zoo as well, with a multiplicity of anaerobes coming to the fore. This month we publish data showing that despite intravenous antibiotics for a CF lung attack (no, we are not giving up on our initiative), primarily directed against aerobes, the anaerobic community within the airway remained largely unchanged. The patients improved clinically, so is this a case of ‘so what?’ We do not think so—it is difficult to believe that these anaerobes are beneficial, and clinical improvement during a CF lung attack is one thing, …